Evaluating the design of the Integrated Care for Older People: a theory of change approach.

Introduction: Given the progressive aging of the population, there is an urgent need at the health system level to implement effective models to care for older people (OP). Healthy aging is imperative to reach the Sustainable Development Goals. The World Health Organization (WHO) developed the Integrated Care for Older People (ICOPE) strategy to address this challenge. Implementing ICOPE requires its adaption to a specific context. We propose a pathway for such adaptation through an evaluation of the design of ICOPE; thus, we aim to describe the Theory of Change (ToC) of ICOPE and evaluate it for its implementation in Mexico City. Methods: Based on the WHO and published literature documentation, we drafted an initial ToC for ICOPE. Then, we validated the ToC with experts in ICOPE, after which we evaluated and refined it by discussing the causal pathway, intervention required to activate it, rationale, and assumptions in consecutive workshops with 91 stakeholders and healthcare workers, using the nominal group technique to reach a consensus. Results: The resulting ToC has the potential to contribute to healthy aging by three expected impacts: (1) prevention, reversal, or delaying of the decline of intrinsic capacity (IC) in OP; (2) improvement of the quality of life of OP; and (3) increase of disability-free life expectancy. The ICOPE causal pathway had ten preconditions, including the availability of resources, identifying at-risk individuals, available treatments, and evaluating results. Discussion: We adapted ICOPE to a specific implementation context by evaluating its ToC in a participatory process that allows us to identify challenges and address them, at least in terms of the guidelines to operate the strategy. As ICOPE is an approach for a primary healthcare system, its adoption in a community healthcare program is promising and feasible. Evaluation as a tool could contribute to the design of effective interventions. The evaluation of the design of ICOPE for its implementation contributes to the strength of its potential to improve care for OP. This design for implementing ICOPE has the potential to be applied to similar contexts, for example, in other lower-middle-income countries.

Instructional Design and Its Usability for Branching Model as an Educational Strategy.

INTRODUCTION: Serious Games (SG) are an educational strategy used in the health professions with positive results in teaching diagnosis and facilitating the application of concepts and knowledge transfer. A type of SG is the branching scenario, which has the potential for a linear story or multiple options to achieve learning goals. There must be evidence for this type of SG's instructional design (InD) and usability. OBJECTIVE: Propose an InD for the branching scenario and rate its usability. MATERIALS AND METHODS: We conducted a two-phase study. In the first phase, we drafted an InD based on the literature review, and then, we applied an expert validation process through a modified Delphi technique. With the consent of InD, we built five branching scenarios. In the second phase, we apply an instrument to measure the SG usability of the branching scenarios in a cross-sectional study with 216 undergraduate medical students. RESULTS: A proposal for an InD for branching scenarios was elaborated. This InD has five dimensions with steps and definitions that help the designer fulfill the requirements for the SG. With the InD, we developed five branching scenarios for undergraduate medical students. Finally, the rates for the usability of the branchings had high scores. The branching SG with multiple options offers different outcomes for the same clinical problem in a single activity. DISCUSSION: The proposal of a specific InD for branching scenarios considered SG theory and was tested, at least in user usability. The steps proposed include the specificity of the requirements of an SG, such as levels, checkpoints, avatars, and gameplay characteristics, among others, in contrast to the other InD that do not explicitly consider them. One of the limitations of this study is that we applied it only using the H5P software to develop branching scenarios with no other evidence of the performance of the InD in different contexts or platforms. CONCLUSIONS: We propose using an InD to construct branching scenarios. This kind of SG has specific characteristics for its correct operation. Using structured steps in developing SG improves the probability of developing decision-making skills. Using an instrument to assess the usability of at least one dimension of the SG is also recommended to identify opportunity areas.

Readiness for Integrated Care of Older People: A Cross-Sectional Study in Mexico.

AIM: To evaluate the readiness of the Mexican healthcare system to implement the integrated care for older people (ICOPE) approach into an existing healthcare model. METHODS: We conducted a cross-sectional study with data from 2473 healthcare workers analyzed using the model for understanding success in quality (MUSIQ) framework to gather data from healthcare professionals. Their perceptions regarding the readiness for ICOPE were assessed across five dimensions: team, microsystem, infrastructure, organization, and external environment. RESULTS: Only 717 (29%) of the participants believed ICOPE could be successfully implemented in Mexico without any modifications. A total of 1261 (51%) participants rated the readiness of ICOPE with some barriers. The main barriers were reallocating resources and the external environment. OBSERVATION: Mexico's healthcare system faces barriers to innovation that could hinder the successful integration of the ICOPE approach. A systematic identification of these barriers provides an opportunity to suggest adaptations and refinements to increase the probability of success. Using the contextual factors identified as facilitators and the proposal of interventions such as the ICOPE app could improve the chances of success. CONCLUSION: The participants of this study evaluated ICOPE as ready to implement, with some contextual barriers. The readiness evaluation supports the stakeholders' and policymakers' decisions in implementing and monitoring the program in a natural setting. Evaluating the readiness of the intervention increases the possibility of aligning the innovation with contextual factors, increasing the chances of its successful adoption and implementation.

Who Can Debriefing Assessment for Simulation in Healthcare? Different Perspectives on Teledebriefing Assessments.

INTRODUCTION: Virtual debriefing is a cardinal element to achieve the effectiveness of telesimulation. There are different instruments to assess face-to-face debriefing to determine the degree of effectiveness of debriefing; Debriefing Assessment for Simulation in Healthcare (DASH) instrument is one of them. This study aims to describe and compare the evaluation of raters, instructors, and students during a virtual debriefing using the DASH. METHODS: A cross-sectional study was performed evaluating the virtual debriefing of 30 instructors after a heart failure telesimulation scenario. The evaluation was conducted by 30 instructors, 338 undergraduate students in the seventh semester, and 7 simulation raters. The 3 versions of the DASH instrument in Spanish were applied, respectively. RESULTS: Two comparisons were made, student versus instructor and rater versus instructor. Cronbach α was 0.97 for each version. The averages of the results on the DASH instrument were: 6.61 (3.34-7.0), 5.95 (4.65-7.0), and 4.84 (2.68-6.02) for student, rater, and instructor versions, respectively. The size effect between student and debriefer perspectives was 0.42. In contrast, the size effect between instructor and rater was 0.72. All differences were significant. CONCLUSIONS: There are different rates between the persons who use the DASH. In this study, from the perspective of the instructor and rater, the difference was 1 point with a wide range, in contrast with the difference between instructor and student, which is relatively minor. It is necessary to consider the perspectives of experts in the subject to achieve a virtual debriefing of high quality and improve a debriefing by using the DASH.

El aprendizaje activo y el desarrollo de habilidades cognitivas en la formación de los profesionales de la salud / The active learning and the development of cognitive abilities in the academic training of health professions

En esta revisión se presentan las habilidades cognitivas como el objetivo del aprendizaje activo y se explican brevemente cada una de las estrategias didácticas que facilitan su logro. Como docentes, nuestro papel es el de experto disciplinar, y para fomentar las competencias de los estudiantes de Ciencias de la Salud podemos incorporar de forma racional cada una de las estrategias que se presentan en este artículo a nuestro portafolio didáctico sin perder de vista el resultado de aprendizaje, competencia o capacidad que deseamos que nuestros estudiantes alcancen. Este documento busca ser una disonancia cognitiva para los docentes de las Ciencias de la Salud, que los invite a profundizar, evaluar y reflexionar sobre su práctica, así como sobre los resultados que han obtenido hasta ahora con las estrategias vigentes y en un futuro próximo incentivarlos a probar nuevos métodos que promuevan su creatividad en los espacios académicos; principalmente, comprender que este abanico de posibilidades permitirá dinamizar la interacción del grupo, y promover el desarrollo de habilidades interpersonales y de comunicación para la conformación de una comunidad educativa que facilite la formación integral de los futuros profesionales de la salud.(AU)

In this review, cognitive skills are presented as the objective of active learning and each of the didactic strategies that facilitate their achievement are briefly explained. As teachers our role is being a disciplinary expert, and to promote the competencies of Health Sciences (HS) in the students. To achieve this, we can rationally incorporate each of the strategies presented in this article to our didactic portfolio without losing sight of the result of learning, competence, or ability that we want our students to achieve. This document seeks to be a cognitive dissonance for HS teachers, inviting them to deepen, evaluate and reflect on their practice, as well as on the results they have obtained to date with current strategies and in the near future encourage them to try new methods that trigger their creativity in academic spaces. Above all, understanding that this range of possibilities will make it possible to stimulate group interaction, promote the development of interpersonal and communication skills for the formation of an educational community that facilitates the comprehensive training of future health professionals.(AU)

Propuesta metodológica para mejorar la calidad en el diseño de un objeto virtual de aprendizaje: una experiencia con el equipo de protección personal / Methodological proposal to improve the quality of a virtual learning object: an experience with personal protection equipment

Introducción: Los objetos virtuales de aprendizaje (OVA) son una herramienta del proceso enseñanza-aprendizaje. En la bibliografía hace falta una evidencia del proceso de creación de un OVA de calidad. El objetivo de este manuscrito es realizar una propuesta metodológica para diseñar un OVA con el modelo de ADDIE y evaluar su calidad con el Learning Object Review Instrument (LORI). Material y métodos: Se diseñó un OVA con el objetivo de capacitar a estudiantes y personal de salud en la colocación y la retirada del equipo de protección personal. El diseño se realizó por medio del modelo ADDIE y posteriormente se evaluó con el LORI. Resultados: El promedio obtenido del total de respuestas de 355 estudiantes fue de 4,66, con una moda de 5 y una mediana de 4,75. El elemento mejor evaluado fue el dos, que está relacionado con el logro de las metas y objetivos, con una media de 4,73, y el elemento peor evaluado fue el cinco, relacionado con la presentación del OVA, con una media de 4,6. Conclusiones: El uso de una metodología que incluye el diseño y la evaluación de un OVA asegura la reproducibilidad, la sistematización y la mejora continua de la herramienta didáctica.(AU)

Introduction: Virtual learning objects (VLO) are tools in the teaching-learning process. In the literature poor evidence of the process of creating a quality VLO is found. The objective of this manuscript is to build up a methodological proposal to design a VLO with the ADDIE model and evaluate its quality with the Learning Object Review Instrument (LORI). Material and methods: A VLO was designed with the objective of training students and health personnel in the placement and removal of personal protective equipment, the design was carried out through the ADDIE model, later it was evaluated with the LORI. Results: The average obtained from the total responses of 355 students was 4.66 with a mode of 5 and a median of 4.75, the best evaluated element was two with a mean of 4.73 that is related to the achievement of goals and objectives, the worst evaluated element was five with a mean of 4.60 related to the presentation of the VLO. Conclusions: The use of a methodology that includes the design and evaluation of an VLO ensures the reproducibility, systematization, and continuous improvement of the teaching tool.(AU)

Implementation Barriers in Telesimulation as an Educational Strategy: An Interpretative Description.

Introduction Telesimulation is one of the different methodologies for distance learning to promote competency in medical trainees. This methodology needs to have professors, students, and standardized patients in one session to perform a teleconsultation. Telesimulation could lead to multiple implementation barriers. This study aims to describe the implementation barriers through the perspective of the professors, students, and standardized patients in a telesimulation scenario in undergraduate medical education. Method We designed and applied a telesimulation scenario in undergraduate medical students. Then we conducted an online questionnaire with the critical incidents technique. The study sample was 18 professors, 26 standardized patients, and 407 students Results We describe a taxonomy with five categories and each one with different subcategories: knowledge (clinical simulation, theoretical over the clinical case, and use of simulators), facilities (access, time of use, and functionality), financing (payment to staff and purchase of equipment), attitude (acceptance and emotion), and participants (communication, collaborative work, and debriefing). Conclusion The description of the implementation barriers through multiple perspectives generates a taxonomy that could improve the quality of the telesimulation. This taxonomy is a proposal to consider the design, implementation, and evaluation when a telesimulation is implemented. The taxonomy could generate a structured plan when the educators implement the telesimulations at their own institutions considering all the barriers proposed.

Burnout en estudiantes del Plan de Estudios Combinados en Medicina, Facultad de Medicina, Universidad Nacional Autónoma de México / Burnout in students of the Program of Combined Studies in Medicine, Faculty of Medicine, National Autonomous University of Mexico

Introducción: El Plan de Estudios Combinados en Medicina está diseñado para que alumnos sobresalientes que cursan la carrera de medicina estudien el doctorado simultáneamente. Las exigencias para culminar el posgrado involucran situaciones de estrés que podrían llevar al desgaste. El burnout es un síndrome con tres dimensiones: agotamiento emocional, cinismo e ineficacia, que pueden disminuir las expectativas de éxito, satisfacción y rendimiento académico. Objetivo: Determinar la frecuencia de burnout y sus dimensiones en estudiantes de seis generaciones del programa, así como su correlación con características sociodemográficas, académicas y hábitos. Sujetos y métodos: Los alumnos respondieron voluntariamente un cuestionario autoaplicado y el Maslach Burnout Inventory-Student Survey. Se calculó la prevalencia de las dimensiones del burnout y se correlacionaron con variables evaluadas en el cuestionario usando la prueba exacta de Fisher. Resultados: Los 56 participantes no presentaron burnout y un 61% tampoco las dimensiones del síndrome. Solas o combinadas, un 27% mostró ineficacia; un 11%, cinismo, y un 7%, agotamiento. La prevalencia de dos dimensiones fue del 5%. Se encontraron diferencias significativas (p < 0,05) para la relación con el grupo, tocar un instrumento, cantar o actuar, sitio de residencia y la violencia en el traslado. Conclusiones: La ausencia de burnout en los participantes posiblemente refleja satisfacción y compromiso académico. La pésima relación con compañeros y la violencia en el traslado son frecuentes en alumnos con agotamiento. Es posible que tocar un instrumento, cantar o actuar constituya una respuesta al agotamiento y al cinismo, así como otras estrategias de afrontamiento no exploradas en este estudio

Introduction: Combined Studies in Medicine is a program in which outstanding students pursue a career in Medicine and simultaneously a doctorate. The requirements to complete the graduate course involve stress situations that could lead to burnout. Burnout is a syndrome with three dimensions: emotional exhaustion, cynicism and inefficiency, which can diminish the expectations of success, satisfaction and academic performance. Aim: To determine the frequency of burnout and its dimensions in students of six generations of the program as well as its correlation with habits, sociodemographic and academic characteristics. Subjects and methods: Students voluntarily answered a self-applied questionnaire and the Maslach Burnout InventoryStudent Survey. The prevalence of the dimensions and burnout were calculated and were correlated with variables evaluated in the questionnaire using the Fisher's exact test. Results: The 56 participants were negative to burnout and 61% to the dimensions; 27% had inefficiency, 11% cynicism and 7% exhaustion, combined or alone. The prevalence of two dimensions was 5%. Significant differences were found (p < 0.05) for the relationship with colleagues, playing instruments, singing/acting, place of residence and violence on the way to the stay. Conclusions: The absence of burnout in the participants possibly reflects satisfaction and academic commitment. The bad relationship with colleagues and the violence on their way to the stay are frequent in students with exhaustion. It is possible that playing instruments, singing or acting was a response to exhaustion and cynicism, as well as other coping strategies not explored in this study